Cervicogenic Headache: How Is It Treated?
A headache is not just a headache. Some headaches do originate from structures in the upper cervical spine as you learned in the first part of this series: Cervicogenic Headache: What is it? The muscles, ligaments, joints, and nerves in the upper cervical spine have an interdependent relationship with the head. Any dysfunction in this area leads to the typically unilateral head pain of a cervicogenic headache. Treatment of such head pain must address the cervical source. Non-surgical management stems from two schools of thought. The chiropractic approach relies on manipulative treatment of the joints and the bones like the “atlas” (which is the first cervical vertebral body). The physical therapy approach relies on muscular retraining. A blend of both manual therapy and rehabilitative therapy is usually the best way to conservatively treat a touchy upper cervical spine which causes headaches.
Can joints and bones of the spine get out of alignment? Yes, yes they sure can. And yes, manipulative realignment of the joints and bones can relieve pain. But for how long? Some say the improvements in movement and alignment gained from manipulative therapy only last 48 hours. Most patients would agree that the benefits of readjustment do not last. A leading researcher in the area of cervicogenic headaches says, “Relief of a headache as an immediate response to treatment is unlikely to be translated into long-term relief”. The problem with maintaining alignment lies with the dysfunction of the muscles and nerves which support and control the joint. Without addressing the neuromotor control of the spine, a treatment program based solely on manipulation is just treating half of the problem.
The other half of the problem lies with spinal posture and muscle function. In the first article about Cervicogenic Headaches, the important influence of spine posture was discussed. A forward head position places abnormal strain on the back of the neck as the spine compensates with increased lordosis. Furthermore, the muscles around the shoulder blades are a crucial part of the relationship between the head and neck. When these muscles get weak and are unable the hold up the weight of the arms, more load is placed on the neck and head. The other muscles that are critical for treating a cervicogenic headache are the deep neck flexors (deep muscles in front of the throat). When these flexor muscles become weak, the neck extensor muscles overpower the cervical spine and place stress on the structures in the back of the neck. All of this muscle weakness translates into joint imbalances, misalignments, and abnormal movement patterns. On the other hand, a treatment program based solely on muscle retraining is also just treating half of the problem.
The solution to managing cervicogenic headaches in a non-surgical manner is to treat the entire problem. Joints and bones need to be realigned. Once realigned, the alignment needs to be maintained through a neuromuscular retraining and rehabilitation program. Without this comprehensive approach, successfully breaking the cycle of cervicogenic headaches is very unlikely. If not treated properly, this headache will return again and again and again. Break the cycle by finding a therapist who has both a manual and rehabilitative approach.
Christina Lasich, M.D., wrote about chronic pain and osteoarthritis for HealthCentral. She is physiatrist in Grass Valley, California. She specializes in pain management and spine rehabilitation.